A new study has found that more than one-third of Iraq and Afghanistan war
veterans who enrolled in the veterans health system after 2001 received a
diagnosis of a mental health problem, most often post-traumatic stress disorder
or depression.
The study by researchers at the San Francisco Department of Veterans Affairs
Medical Center and the University of California, San Francisco, also found that
the number of veterans found to have mental health problems rose steadily the
longer they were out of the service.
The study, released Thursday, was based on the department health records of
289,328 veterans involved in the two wars who used the veterans health system
for the first time from April 1, 2002, to April 1, 2008.
The researchers found that 37 percent of those people received mental health
diagnoses. Of those, the diagnosis for 22 percent was post-traumatic stress
disorder, or PTSD, for 17 percent it was depression and for 7 percent it was
alcohol abuse. One-third of the people with mental health diagnoses had three or
more problems, the study found.
The increase in diagnoses accelerated after the invasion of Iraq in 2003, the
researchers found. Among the group of veterans who enrolled in veterans health
services during the first three months of 2004, 14.6 percent received mental
health diagnoses after one year. But after four years, the number had nearly
doubled, to 27.5 percent.
The study’s principal author, Dr. Karen H. Seal, attributed the rising number of
diagnoses to several factors: repeat deployments; the perilous and confusing
nature of war in Iraq and Afghanistan, where there are no defined front lines;
growing public awareness of PTSD; unsteady public support for the wars; and
reduced troop morale.
Dr. Seal said the study also underscored that it can take years for PTSD to
develop. “The longer we can work with a veteran in the system, the more likely
there will be more diagnoses over time,” said Dr. Seal, who is co-director of
the mental health clinic for Iraq and Afghanistan veterans at the San Francisco
veterans medical center.
The new report joins a growing body of research showing that the prolonged
conflicts, where many troops experience long and repeat deployments, are taking
an accumulating psychological toll.
A telephone survey by the RAND Corporation last year of 1,965 people who had
been deployed to Iraq or Afghanistan found that 14 percent screened positive for
PTSD and 14 percent for major depression. Those rates are considerably higher
than for the general public.
“The study provides more insight as to just how stressed our force and families
are after years of war and multiple deployments,” said René A. Campos, deputy
director of government relations for the Military Officers Association of
America. “Our troops and families need more time at home — more dwell time,
fewer and less frequent deployments.”
The study was posted Thursday on the Web site of The American Journal of Public
Health.
Dr. Seal cautioned that, unlike the RAND study, the results from her research
could not be extrapolated to the roughly 1.6 million veterans who have served in
Iraq or Afghanistan because about 60 percent of them were not receiving health
care through the veterans system.
But she noted that the number of Iraq and Afghanistan war veterans receiving
care through the veterans system was at a historic high, 40 percent, potentially
making the study’s results more universal.
The study also found that veterans older than 40 with the National Guard or the
Reserves were more likely to develop PTSD and substance abuse disorders than
those under 25. A possible reason, Dr. Seal said, is that older reservists go to
war from established civilian lives, with families and full-time jobs, making
combat trauma potentially more difficult to absorb.
“It’s the disparity between their lives at home, which they are settled in, and
suddenly, without much training, being dropped into this situation,” she said.
In contrast, the study found that among active-duty troops, veterans under 25
were more likely to develop PTSD and substance abuse problems than those over
40, possibly because those younger troops were more likely to have been involved
in front-line combat, Dr. Seal said.